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Chapter 68: Otitis Media Buttaro: Primary Care: A Collaborative Practice, 6th Edition
from TEST BANK; Buttaro: Primary Care Interprofessional Collaborative Practice 6TH EDITION. All Chapters
by StudyGuide
Multiple Choice
1. A pediatric patient’s assessment confirms the patient has otalgia, a fever of 38.8°C, and a recent history of upper respiratory examination. The examiner is unable to visualize the tympanic membranes in the right ear because of the presence of cerumen in the ear canal. The left tympanic membrane is dull gray with fluid levels present. What is the correct action?
a. Perform a tympanogram on the right ear.
b. Recommend symptomatic treatment for fever and pain.
c. Remove the cerumen and visualize the tympanic membrane.
d. Treat empirically with amoxicillin 80 to 90 mg/kg/day.
ANS: C a. A 36-month-old with fever of 38.5°C, mild otalgia, and red, non-bulging TM b. A 4-year-old, afebrile child with bilateral otorrhea
The AAP 2013 guidelines strongly recommend visualization of the tympanic membrane to accurately diagnose otitis media and not to treat based on symptoms alone. The practitioner should attempt to remove the cerumen to visualize the tympanic membrane. A tympanogram cannot be performed when cerumen is blocking the canal. Because the child may have an acute ear infection, antibiotics may be necessary.
2. Which patient may be given symptomatic treatment with 24 hours follow-up assessment without initial antibiotic therapy?
NURSINGTB.COM c. A 5-year-old with fever of 38.0°C, severe otalgia, and red, bulging TM d. A 6-month-old with fever of 39.2°C, poor sleep and appetite and bulging TM
ANS: A
Children older than 24 months with fever less than 39°C and nonsevere symptoms may be watched for 24 hours with symptomatic treatment. Children with otorrhea, those with severe AOM, and any children with fever greater than 39°C should be given antibiotics.
Multiple Response
1. Which symptoms in children are evaluated using a parent-reported scoring system to determine the severity of pain in children with otitis media? (Select all that apply.)
a. Appetite b. Difficulty sleeping c. Level of cooperation d. Poor hearing e. Tugging on ears
ANS: A, B, E
Decreased appetite, difficulty sleeping, and tugging on ears are part of the Acute Otitis Media Severity of Symptom Scale used to evaluate pediatric pain. Children may refuse to cooperate for reasons other than pain. Poor hearing is not part of the pain assessment.
